| NPI | 1265659049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CO 7348) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: CO 7348) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2007-07-08 |